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PRIME THERAPEUTICS SPECIALTY PHARMACY LL
CH053200 HealthNet, Inc.
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Covered Entity Details
Entity Name
HealthNet, Inc.
Subdivision Name
HealthNet Administration/HealthNet Specialty Care at Barrington
Type
HRSA-Funded Health Center
340B ID
CH053200
Entity Address
3403 E Raymond St
Indianapolis, IN 46203
Grant Number
H80CS00114
Participating Start Date
12/1/1992
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
PRIME THERAPEUTICS SPECIALTY PHARMACY LL
Pharmacy Address
ALLIANCERX WALGREENS PRIME #16568
2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDO, FL 32819-9992
Pharmacy Comments
Contract Details
Approval Date
7/3/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Donald Trainor, Chief Medical Officer
(317) 957-2032
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/3/2018
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